Conceptual ideas about human pathology in the light of the working out approach to the pathogenetic therapy.

According to the modern World public health service society classification there are more than 30 000 independent nosologic forms (diseases). It is inconceivable that each of these one's has its own etiology (cause) and the more so its own independent pathogenesis according to the nosologic form determination.

In addition unification of the existing nosologic one's according to the current dividing according to subject headings is very conditionally. Variety of diseases requiring multidisciplinary approach (for example, hepatolenticular degeneration) accentuates convention of that dividing to an even greater degree.

These simple arguments can serve as base for further reasoning and understanding main point of the matter.

To tell the truth, diseases are realized by means of strict determined and not numerous mechanisms conditioned by the human nature granting the all variety of etiologic factors.

To tell strict, the concept of pathogenesis is so conditionally as existing dividing according to subject headings. It is more correct to say about reaction of organism as an effect of pathologic situation within its physiologic opportunities. I.e., pathogenesis is protective reaction of organism as an effect of external and internal factors exceeding the level of physiologic admissibility. In this connection, the concept of “pathogenesis” is interaction of the pathologic factor and the natural protection mechanisms including compensatory ones.

One way or another, any pathologic process can be realized on the following kinds:

• Harmful factor is too considerable and exceeds the level of physiologic compensation. Or compensatory possibilities are very weakened. The result of this situation is death.
• Value of harmful factor doesn't exceed the level of physiologic compensation. Compensatory processes lead to the full compensation of the pathologic process. The result of this situation is recovery.
• Harmful factor gets on the organism at the long-term trend and exhausts compensatory possibilities. Or a pathologic agent can't be compensated by the organism in full measure. In this case some balance and chronometry of the pathologic process in clinical picture come into existence. Exactly this variant is of high our interest, as the most so named somatic, neurological diseases and after-actions of craniocerebral injury, vascular catastrophe, etc. assume a chronic character.

The actual Medicine task is to raise the living quality of the sick within steady remission based on the organism compensatory possibilities.

The tactical task is to provide early activation of these compensatory possibilities, which begins at the critical and the most critical disease's periods. It permits to restrict a destroying effect of the pathologic agent and to prevent a process chronometry.

These two tasks are the foundation-stone of the present wide developed methodology of recovery treatment.

On the basis of these common ideas we have developed and introduced into medicine practice and used successfully a number of the methodological and methodical approaches.

Vegetative nervous system

In our opinion, a role of the vegetative nervous system (further as VNS) in pathogenesis of so named internal diseases is not assessed in full measure at the present moment. The most, what modern specialists discuss, is the role of VNS as premorbid background. Meanwhile, balanced VNS state is responsible for a functional state of all internal organs, what is the base of health.

We think, disbalance in VNS is the basis of practically any somatic disease. We understand under concept “disbalance” as the most simply and sympathetic and parasympathetic link of VNS or oppression one of them.

The following important moment of internal organs pathology understanding is an excitation focus and oppression focus existence within VNS and a wide irradiation of this state opportunity within practically the all VNS. Exactly this fact has a solution of many difficult to understand signs of diseases. This is indeed, VNS structure is based and realized on the “net” principle. Any VNS department is closely connected with another definite removed part of the system.

It is essential to indicate, that a reticular formation of the brain trunk on its all levels including cellular one has an essential resemblance with the peripheric VNS structure. The reticular formation of the brain trunk simultaneous is an equal, in the brain placed department of the peripheric VNS structure. At that, when we say: VNS has central regulation's role, it means: it's misestimated. Most probably it executes connection's function between the peripheric VNS and the brain both in afferent meaning and in efferent meaning.

In our opinion, the VNS coordinating and regulating centre and is heavy accumulation of vegetative neuron placing in the celiac plexus.

It is well-known that a number of neurons in the celiac plexus exceeds a number of neurons in the brain. According to the phylogenetic theory the celiac plexus is an analogue of a ancient “abdominal” brain, which have interior classes of animals.

At that, the neurons of vegetative ganglions are exported to the peripheric sphere. And they have not special protective barriers in contrast to central neurons. Therefore any endured harmfulness (infection, intoxication, trauma, etc. and external medium change and its negative factors) has influence on the neurons and leaves indelible traces. In this case the matter is about vegetative memory of the organism. This memory fixes so as brain the all actions of the organism internal medium.

It is necessary to note that the vegetative ganglions are original neuroendocrinal formation producing a lot of neuromediators, endorphins and hormone similar substances too. Therefore any important modifications in the VNS activity are accompanied by important modifications in the mediator endocrine background of the organism. These modifications affect on the functional activity of the internal organs and can bring to disease's development by concurrence of definite circumstances.

Taking into account the above named it is impossible to say about pathology of any organ. The pathology is determined by organism's available predispositions showing in medicine well-known principle “Locus minoris resistentia”.

In this connection it is necessary to take into account the possibility of VNS segmental disbalance. If this segment falls outside the controls of the VNS control regulating departments (celiac plexus), the developing disfunction of the segment managing organ bring to morphologic disturbances some time or other. However even by the essential affection of the organ a balanced vegetative management has ability to reconstruct its functional abilities. This fact determines the scope of medicinal tactics aimed at the VNS regulation within the bounds of the earliest prevention of morphologic disturbances and of influence to the organ's function even by formed secondary morphologic disturbances.

Clinic diagnostic of a vegetative disfunction is effected considerably easy according to the methods developed by Academician Markelov. At that painfulness of solar ganglia and index of vegetative irritation are determined.

On the face of it painfulness of solar ganglia by the VNS pathology is paradoxically according to the above named. However there is not antinomy, as the VNS is built by the principle of the syncytium with a lot of short and long reverberated ansae having both afferent and efferent arms. Therefore coordinating role of solar ganglia in the VNS function can combine with their secondary disfunction caused by distant irritation focus.

To understand this moment is necessary to depart from the ranking principle in VNS building and activity. That can be so named as rights equality of the all VNS departments by the coordinating role of celiac plexus.

It is necessary to discuss the role of the brain in the regulation of the vegetative functions special. At one time the ideas of nervosism advanced by Academician I.P.Pavlov were developed in the workers of Academicians Bykov, Kurzin, Tchernigovsky. They proved the regulated influence of brain to the vegetative functions.

At the same time Academicians Orbeli and Markelov proved the ability of opposite interactions, i.e. powerful influence of the VNS to activity of the whole Central Nervous system (further as CNS). It is considerably to recall that the volume of incoming into brain vegetative afferentation is a considerable part of the all afferent flow managing direct functional state of brain.

Therefore, the question is about inter-added influences. This fact is allowed to reject the thesis about managed influence CNS to VNS as unilateral ones.

Certainly, an animal has begin of gastric juice secretion process, when it sees food. On the other hand an animal behaves so complex to see food according to the vegetative action of “hungry” stomach. Thus it is difficult to determine the leading link in interaction between CNS and VNS.

Therefore it is possible to influence to the CNS activity considerable.

The concrete embodiment of the above mentioned ideas is methods of electrical impacts to the celiac plexus. These methods are used by us in practice with success. We get considerable, long improvement and sometimes recovery of diseased for a long time (terms of anamnesis to 25 years, diagnosis: “Diencephalic syndrome”) patients, diseased patients with so named vegetovascular dystonia and any states caused by the first brain affection, particularly parkinsonism and any forms of epileptic fits with a help of these methods. We have good, encouraging results of theses methods by treatment some internal and even dermal (psoriasis) diseases. There can be no doubt that this direction has grand perspective.

Fundamental importance of afferent flows mismatch in pathogenesis of motor disturbances.

The role is not estimated at its true worth the correct role of the afferent flows in organisation's activity of the whole of the CNS and particularly of the brain. The question is about a dominant meaning of the nervosism ideas. These ideas were determined and understood incorrect previously. The brain had the special attitude as a organ of reflective and mental activity. Hence is the idea that the brain has the leading and managing role.

At the same time, the brain is an organ operating according to strict determined mechanisms aimed the basic task - reflection. Hence we understand that the brain activity is determined and managed according to its reflected and afferent formations. The posterior departments: temporal, visual and parietal cortexes belong to these formations. At that the brain is divided in two parts. There is a posterior receiving part and a anterior using part. Although this scheme is conditional as there is independent, anterior somatosensory area in the frontal lobe of the brain. This fact confirms improbable compensatory possibilities of the brain. At that the question, the anterior somatosensory area provides afferent functions by the damage of the brain posterior departments.

The development of the brain begins from its posterior departments and follows into front direction in the ontogenesis and phylogenesis. The frontal lobes are mature as last ones, to the mature age of an organism. It evidences of the importance of the brain posterior departments in the process of information getting and mature of the brain.

It is very important to say that a human being can not active or operate without a correct organized affected synthesis. In this connection any disorganization can bring to gross errors of the brain activity.

According to the modern methods of neurology the motor function can be damaged basic by destruction of the motor centers. At that the afferent paresis connected with sensor conduction tract's and cortex departments affection is possible. Modern neurologists explain that fact as a reflex arch. And the mechanism of the several motor affections is enigma. Modern medicine tries to find their biochemical substratum. This way brings to the confusion of this question. If the Levo-Dop's compound helps diseased patient with Parkinsonism, it doesn't mean that disturbance of a dophaminergical transfer is a pathophysiological base of this disease. In this situation pathophysiological mechanisms and pathogenic causes are confused and brought to the one denominator. This confusion brings to destructive tendencies in the medicine and loses its internal logic.

On the base of the long cervical dystonia treatment experience we prove that pathophysiological base of the disease is afferent flows mismatch. We mean treatment diseases with affection of posture support function with the help of the methods of transtympanal chemical vestibular dereception (further as TTCVD ) and with the help of estimation of functional state of the brain by the methods of computing electroencephalogram (EEG).

With the aim to support posture the following kinds of afferentation take part: vestibular, proprioceptive, visual ones and a common afferent flow. Their activity and interactivity are strict coordinated on many levels of the brain. The leading level is thalamus.

We are sure that the base pathophysiological mechanism of this function affection is a mismatch of vestibular and proprioceptive afferent flows .

The TTCVD method is feasible as pathophysiological one and so high effective.

On the base of our ideas of the motor affections pathogenesis we use the TTCVD method as a treatment method by many CNS diseases.

This method is high effective for patients with spastic gemi-, para-, tetraparesis. It brings to considerable reduction of muscular tonus, expansion of motor abilities, increase power, reduction of disturbances.

In the cause of the Parkinsonism we have the fact of reduction of muscular tonus to the normotonie, reduction of disturbances, propulsions, oligo- and bradykinesia, hypomimia and according vegetative disturbances.

Therefore, the practice provides that the mechanism of afferent flows mismatch is base of these diseases.

There are the following necessary and sufficient conditions for coordination of afferent flows in the normal position:

• timely receiving heteromodal impulses to neuron;
• balance of their characteristics;
• readiness of the neuron to impulses integration.

As a result of the coordination of afferent impulses in neurons of relay and associative nuclei (mainly, thalamic ones) the cortex gets a impulse having synthetic information with common characteristics of heteromodal signals.

The phenomenon of flows mismatch can be in the following situations:

• divergence of the heteromodal impulses incoming in time;
• excess or deficient capacity of a impulse;
• non-readiness of the neuron to the synthetic activity.

This situation can be determined under influences of neurons of other brain structures.

Particularly, we think, that striopallidal system and caudate nucleus execute the such modulator's function to the associative nuclei of the thalamus. So can be explained many clinical displays of so named diseases of basal ganglia system.

Relative excessiveness of the afferent flows as a base of intelligent-mnestical disturbances

We have the opinion that by gross organic brain affections with irreversible disturbances of the full neuronal complexes functions the brain is in the state of afferent overload. The common number of afferent information doesn't conform to its detector possibility.

Such situation can cause various kinds of neurological and even psychoneurological symptomatology. It is logical to suppose that the switching off one of the powerful afferent flows reduces the sensory loading on the brain and makes simply the other information including semantic important one's processing. These processes bring to the clinical recovery.

On our opinion, the base afferent flow is vestibular flow. The vestibular sensibility is the most old according to the phylogenetics. It is true that any human being is always under influence of gravitational field of the Earth. The most ancient forms of organisms had special mechanisms of gravitational vector's indication.

During the evolution the new sensory forms were overbuilt to this basic reception.

The all sensory kinds are structural organized and coordinated on the base of this main vestibular reception. This fact gets this reception the main and leading importance. Therefore, we think that the above mentioned kind of afferention is in the lead of information flows incoming into the brain, as it takes part in the all forms of specified afferention.

As several patients with cervical dystonia gets facilitation, extraction and reproduction of long memory traces as a result of the TTCVD method using and at that the switching off of vestibular reception doesn't bring to invalidated effects, we‘ve used this method by the several kinds of memory disturbances and got a steady positive effect. There is large subjective and objective memory improvement, normalization of psychoemotional disturbances by patients with psychoorganic and Korsakov's syndromes too. These processes bring to the full medical rehabilitation and social readaptation.

Problem of the brain focal destruction

 Vascular diseases of the brain and craniocerebral injury can be become complicated by the development of sharp affections may be in chronic form and with steady neurological deficit.

The main task is the focus minimization, particularly its expansion stopping and the earliest inclusion of perifocal zones.

By the chronic focus there are zones of brain tissue being in the state of the parabiosis. The aim of the recovering treatment is to activate these zones and to include other cortex parts to the affected functions. The last task can be solved by the complexes methods.

At the last time we developed effective the methods of transcranial microelectropolarization - TCMEP . As the results of this method using we provide ability of focus expansion and perifocal edema stopping, resorption processes speeding up.

These effects correspond to the tasks. As a result the terms of recovering shorten twice. Many patients evade surgical intervention.

This method using allows getting considerable results by the effects of the sharp brain catastrophes with steady neurological deficit for the period of 2-3 months and more. In our day-to-day work this method is a part of the complex of the recovery treatment's measures. This complex contents of the above mentioned TTCVD method, FBM (functional biomanagement)method, NDM (neurodynamic management based on the ACFC-2 phenomena). The complexity using gets the best results.

Problem of the patients with “small consciousness”

One of the negative results of craniocerebral injury is incoming of the patient into so named “small consciousness”. The vegetative state, akinetic muthism belong to this “small consciousness”. These states are characterized by absence of connection with an external world and by the full absence of any movements with increasing of the muscular tonus on the flexion type. That can be brought to development of articular contractures. This category of patients hasn't many perspectives. At the present time the modern medicine doesn't know any treatment's methods and relies up on the time factor. The main such patients are lost as a result of connected somatic complications.

The concrete substratum of these states is long parabiotic state of numerous areas of the brain cortex. The earliest and active treatment tactics are directed to the activization of the brain cortex activity and to minimization of the sensory afferent flows. In addition it is necessary to use actions directed to the muscular tonus reduction.

In the connection with the above mentioned we've developed the original complex treatment methods for these heavy categories of the patients. Taking into account the mechanism of micro polarization it is necessary to use these methods.

The positive results allow hoping the wide development of this method. We can note the quick (2-3 weeks) activation of such patients, the muscular tonus reduction, the spontaneous movement activity expansion, features of self-service (min. self-swallowing), elementary speech contact by speech cortex zones support. This clinical dynamic are accompanied by positive dynamic of EEG. Our results are basis for development of this method further on.

Problem of DAI

The syndrome of diffusive axonal injury (DAI) belongs to the category of craniocerebral injury and can realizes in two principle ways: the first - with the brain trunk lesion, the second - with the partial brain hemispheres lesion. The practice shows that by the partial brain hemispheres lesion their mediobazal departments are damaged. In this case the treatment terms are very long and the final result can be unforeseen. At the present time the modern medicine doesn't know effective treatment's methods and relies up on the time factor.

By the brain hemispheres lesion diagnostics the leading position has EEG.

We suggest the new methods presenting the above mentioned TTCVD method of the mediobazal and brain trunk structures. These methods can recovery the patients within 2-3 weeks, allows restoring the patient to health in their intellectual ability and activity, to shorten the treatment terms. There are positive changes in electric diagnostics.

Summary

Thus, the stored by us material is singular choice in the understanding and treatment of many heavy brain lesions. As a result of our recognition there are original conceptions of the pathophysiological mechanisms of the brain and the high effective methods being as a choice to medicamental and medicosurgical treatments.

The basic advantage of these methods is their simplicity, small expenditure and invasiveness and safety.

The suggested methods are the first methods. They can be the base for establishment the concrete direction of the recovery medicine. We intend to follow our development in this medical area further on.

Russia, St.-Petersburg, 2004